Fungal empyema in complicated chronic pancreatitis: A rare possibility

INTRODUCTION: Fungal empyema a rare cause of empyema thoracis is commonly associated with nosocomial infection or gastrointestinal disease with very high mortality. Its association with chronic pancreatitis is rarely been described. PRESENTATION OF CASE: We present a case of young male known alcoholic with chronic pancreatitis and cystgastrostomy who presented with dyspnea and fever. Thorough workup showed left sided amylase rich loculated pleural effusion. Culture grew candida albicans. Esophagogram carried out for any esophageal rupture turned out to be negative. Histopathology was negative for malignancy. Intraoperative left sided yellowish colour fluid was drained, Loculation broken and rind removed. No pleuro-peritoneal fistula could be identified. Postoperatively patient remained well and discharged on antifungal. CONCLUSION: No obvious cause of fungal empyema could be found except for pancreatico-pleural spread as suggested by amylase rich pleural effusion along with growth of candida spp. Hence in patient with chronic pancreatitis and cystgastrostomy pleural effusion should be evaluated for fungal infection to avoid morbidity and mortality and commence early treatment

Exploring the future potential of jute in Bangladesh

© 2017 by the authors. Licensee MDPI, Basel, Switzerland. The study assesses the future potential of the jute sector in Bangladesh by examining its growth performance, international competitiveness, profitability, and production efficiency using national time-series data of over the period 1973-2013 and farm survey data from 289 farmers from two major jute growing areas of Bangladesh. Results revealed that the jute sector has experienced substantial growth in area, production, productivity, prices, and exports. However, productivity has stagnated during the latter 10-year period (2004-2013), while it grew at a rate of 1.3% per annum (p.a.) during the first 31-year period (1973-2003). Only traditional jute production is globally competitive, although financial profitability of white jute is relatively higher (benefit cost ratio = 1.24 and 1.17, respectively). Land, labor, and irrigation are the main productivity drivers for jute. The mean production efficiency of jute is estimated at 75% indicating substantial scope to improve yield by eliminating inefficiency. Marginal farmers are relatively inefficient. Policy implications include investments in research and development, irrigation, and tenurial reform and export protection for white jute in order to revive the sector and boost export earnings

Paradigm shift in the surgical training: The era of innovation, simulation and beyond

This is an era of transformation of surgical education and training. Modern methods of training are being introduced at a rapid pace and are being adopted in surgical practice not only to improve the outcomes and patient satisfaction, but also to provide an opportunity to develop a new well-structured training curriculum by integrating both traditional and modern approaches to teach and learn surgical skills. Various surgical simulators are in use as training aids and are constantly undergoing further refinement and development. To achieve a smooth transition in surgical training to modern methods, a structured programme has to be developed and validated to bridge the gaps in terms of safety, efficiency and ethics during the training process

Mid aortic syndrome correction: anaesthetic considerations and management

A twelve years old female patient presented with headache off and on and disparity between upper and lower limb pressures. On the basis of history, physical examination and magnetic resonance angiography, the patient was diagnosed as mid aortic syndrome and planned for elective aorto aortic bypass graft surgery through left thoracotomy. Double lumen endotracheal tube was placed for lung isolation and episodes of hypertension during proximal and distal cross clamp were controlled with sodium nitropruside infusion (SNP). Extra pleural catheter was put in at the end of surgery before chest wall closure for postoperative pain control. Both upper and lower limb pressures were monitored in the cardiac intensive care unit (CICU) and over a period of twenty four hours, gradient gradually reduced to 10 mm Hg

Competitiveness, Profitability, Input Demand and Output Supply of Maize Production in Bangladesh

The study assesses international competitiveness, profitability, output supply and input demand of maize production using a farm survey data of 165 farmers from two major maize growing areas (i.e., Dinajpur and Lalmonirhat districts) of northwestern Bangladesh. Results revealed that maize production is globally competitive and, therefore, can successfully substitute its import. Maize production is also profitable at the farm level (Benefit Cost Ratio = 1.21) with no adverse influence of farm size on yield and profitability. Maize farmers are also responsive to changes in market prices of inputs and outputs. A 1% increase in maize price will increase output supply by 0.4%. The most dominant driver of maize supply and other input demands is land. A 1% increase in available land will increase maize supply by a substantial 3.9%. In addition, landless laborers will benefit through an increase in hired labor demand when land area increases. Policy implications include investments in R&D, tenurial reform to consolidate land holding and smooth functioning of the hired labor market in order to increase maize production and profitability in Bangladesh

AnimalWeb: A Large-Scale Hierarchical Dataset of Annotated Animal Faces

Being heavily reliant on animals, it is our ethical obligation to improve their well-being by understanding their needs. Several studies show that animal needs are often expressed through their faces. Though remarkable progress has been made towards the automatic understanding of human faces, this has regrettably not been the case with animal faces. There exists significant room and appropriate need to develop automatic systems capable of interpreting animal faces. Among many transformative impacts, such a technology will foster better and cheaper animal healthcare, and further advance animal psychology understanding. We believe the underlying research progress is mainly obstructed by the lack of an adequately annotated dataset of animal faces, covering a wide spectrum of animal species. To this end, we introduce a large-scale, hierarchical annotated dataset of animal faces, featuring 21.9K faces from 334 diverse species and 21 animal orders across biological taxonomy. These faces are captured `in-the-wild' conditions and are consistently annotated with 9 landmarks on key facial features. The proposed dataset is structured and scalable by design; its development underwent four systematic stages involving rigorous, manual annotation effort of over 6K man-hours. We benchmark it for face alignment using the existing art under novel problem settings. Results showcase its challenging nature, unique attributes and present definite prospects for novel, adaptive, and generalized face-oriented CV algorithms. We further benchmark the dataset for face detection and fine-grained recognition tasks, to demonstrate multi-task applications and room for improvement. Experiments indicate that this dataset will push the algorithmic advancements across many related CV tasks and encourage the development of novel systems for animal facial behaviour monitoring. We will make the dataset publicly available

Is Grown Up Congenital Heart (GUCH) disease different in a developing country?

Abstract In the current era grown up congenital heart disease (GUCH) patients undergoing surgical interventions are increasing. Most of the interventions in the developed countries are either complex or redo-operations in patients who had previously undergone repair, palliation or correction. However, in the developing countries most of the interventions are primary and corrective. This descriptive retrospective study comprised GUCH patients who underwent surgical intervention for congenital heart disease (CHD) at Aga Khan University Hospital, Karachi, from January 2006 to December 2015. A total of 195 patients had been treated surgically with a mean age of 31.0±13.5 years. Majority of the patients underwent surgical interventions for closure of atrial 109(55.3%) and ventricular 51(26.2%) septal defect. The most common complications were prolonged ventilation 16(8.1%). Overall mortality was 4(2.1%). GUCH in our practice is for primary procedure with simple diagnosis that should have been treated before reaching adulthood as is done in the developed countries

Cervical mediastinoscopy in the diagnosis of lymphadenopathy in South Asia.

Abstract We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 25 years between July, 1990 and August, 2015. Of the 122 patients, records were complete for 88(72%). Mean age was 42.5±12.9 years and 55(62.5%) were male. Overall, 60(68.2%) patients had benign inflammatory diseases; 25 (28.4%) had lymphoma or lung cancer which was accurately staged; 26(29.5%) had tuberculosis; 13(14.8%) sarcoidosis; and 11 (12.5%) had concomitant tuberculosis and sarcoidosis. No mortality or significant morbidity was recorded. Mediastinoscopy was useful in staging bronchogenic carcinoma and influenced the management in this series. It was found to be accurate in the diagnosis of other malignant as well as benign mediastinal pathologies, all of which were treatable

Role of leptin and its receptors in the pathogenesis of thyroid cancer

Leptin is a multifunctional adipose-derived cytokines that play a critical role in bodyweight homeostasis and energy balance. Recently, leptin and leptin receptor dysreulation have been reported in variety of malignant cells including thyroid. Leptin modulates growth and proliferation of cancer cells via activation of various growth and survival signaling pathways including JAK/STAT, PI3-kinase/AKT and/or Map kinases. In this review, current understanding of leptin\u27s role in the pathogenesis of thyroid cancer has been described